Abdelhamid Mohamed F, Wall Michael L, Vohra Rajiv K
Department of Vascular Surgery, University Hospital Birmingham NHS Foundation Trust, Selly Oak Hospital, Birmingham, UK.
Vasc Endovascular Surg. 2009 Dec;43(6):571-7. doi: 10.1177/1538574409334827. Epub 2009 Jul 29.
Pseudoaneurysm (PA) after carotid endarterectomy (CEA) is a rare complication with incidence less than 1%. There is a potential for rupture, embolization, thrombosis or compression of cranial nerves.
We reviewed our experience and compare it to the literature to raise awareness of this rare though serious condition. It is crucial to treat these patients early to avoid the hazardous consequences.
A review of the case records of patients who had CEA at University Hospital Birmingham (UHB) NHS Foundation Trust from 1990-2007, was undertaken. Information of patients including their aetiology, presenting features, treatment and results was collected. The English-language literature was searched using PubMed database for post CEA pseudoaneurysm.
Five patients developed post CEA PA. This represents 0.4% of the 1200 CEA performed at our hospital in the last 18 years. The timing of their presentation varied from three days to eight months after the original operation. All had patch reconstruction after CEA. Patches were intact at exploration of the PAs. There was one death and one stroke. The literature revealed 154 carotid PAs after CEA and two cases following carotid stenting 52 of these cases had infected PA. Patients with synthetic patches have the least incidence of infection. More than 80% had open surgery and 9% had endovascular repair.
Post CEA surveillance is necessary to detect patients with PA early. Factors that favour infection must be avoided. Endovascular repair of carotid PA should be encouraged in specialised centres.
颈动脉内膜切除术（CEA）后假性动脉瘤（PA）是一种罕见的并发症，发生率低于1%。存在破裂、栓塞、血栓形成或压迫颅神经的风险。
我们回顾了我们的经验并与文献进行比较，以提高对这种罕见但严重疾病的认识。早期治疗这些患者以避免危险后果至关重要。
对1990年至2007年在伯明翰大学医院国民保健服务信托基金（UHB）接受CEA的患者的病例记录进行了回顾。收集了患者的病因、临床表现、治疗和结果等信息。使用PubMed数据库检索英文文献中关于CEA后假性动脉瘤的内容。
5例患者发生了CEA后PA。这占我院过去18年1200例CEA手术的0.4%。其出现时间从原手术术后3天至8个月不等。所有患者在CEA后均进行了补片重建。在探查假性动脉瘤时补片完好无损。有1例死亡和1例中风。文献显示，CEA后有154例颈动脉假性动脉瘤，颈动脉支架置入术后有2例。其中52例为感染性假性动脉瘤。使用合成补片的患者感染发生率最低。超过80%的患者接受了开放手术，9%的患者接受了血管内修复。
CEA后进行监测对于早期发现假性动脉瘤患者是必要的。必须避免有利于感染的因素。在专业中心应鼓励对颈动脉假性动脉瘤进行血管内修复。
